Organization
SIMONETTI REALTY INC
Active
Other names
marshall lane manor
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ANN MCCALLUM (OFFICE MANAGER)
(203) 734-3393
Entity
Organization
Contact information
Practice address
101 MARSHALL LN, DERBY, CT 06418-2347
(203) 734-3393
(203) 734-2100
Mailing address
101 MARSHALL LN, DERBY, CT 06418-2347
(203) 734-3393
(203) 734-2100
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
102RH
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000091025
—
CT
Enumeration date
05/02/2007
Last updated
01/18/2012
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